NOTE for Physicians: This section provides detailed information for PCN Change Support Staff who will support you to embed SDH in your clinic. Feel free to review it, but don't worry about the details. Your PCN Practice Coach will work with your clinic to develop an Implementation Plan that addresses your priorities.​​

PATIENTSSOCIAL DETERMINANTS OF HEALTHIN YOUR CLINIC ​

PCN Change Support Staff, based on clinic interest, capacity and competency, will include these practices in Implementation Plans and support clinics to achieve them.

1. Create a welcoming environment for patients by following the 10 steps laid out by EQUIP (Research to Equip Primary Healthcare for Equity)​2. Collect SDH information – Prepare to collect and record in the EMR the following information as part of a patient record that can by analysed for the practice:​ At a minimum:

Adverse Child Experiences(link to workbook including ACEs questionnaires)- The ACE questionnaire measures sources of stress that children may suffer early in life, including abuse, neglect, violence and serious household dysfunction. Considerable and prolonged stress in childhood has life-long consequences on physical and mental health and well-being, including possible disruption of early brain development, compromised nervous and immune systems, behavioural problems and chronic illness.

Attachment, medical and psychiatric issues- BC’s Health Connections clinic has developed the AMPs questionnaire to delve into SDH issues. Please note that, while the AMPS tool has not yet been validated, it has been used since 2014 within Vancouver Coastal Health’s owned and operated CHCs, to support over 450 clients.

​3. Develop individualized plans for patients, including:

Income support – Poverty: A Clinical Tool for Primary Care Providers outlines income support options for your patients, provided they have completed their tax forms. Ask all patients, “Have you filled out and sent in your tax forms?” If not, connect them with Free Community Tax Clinics. ​

Social and other support – Access community resources available to assist with housing, food and basic needs, education/training, employment, transportation and legal/advocacy support. Research local connections with the team to link patients to needed services, or access bc211 for a list of services available. Call the trained Information and Referral Specialists at ‘211’ for guidance on individual patients.

5. Introduce a Feedback Box in the waiting room, and ask specific questions related to SDH on feedback cards.

​6. ​ Advocacy– Political change is necessary for full system-wide implementation of SDH. If you are keen, consider acting as aHealth Advocate for your patient. Learn about advocacy from the CMA training program. Help is also available from social workers, health navigators and programs such as Basics for Health.